Healthcare Provider Details

I. General information

NPI: 1417975483
Provider Name (Legal Business Name): ALEGENT CREIGHTON HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17030 LAKESIDE HILLS PLZ
OMAHA NE
68130-2396
US

IV. Provider business mailing address

PO BOX 772650
CHICAGO IL
60677-0001
US

V. Phone/Fax

Practice location:
  • Phone: 402-758-5060
  • Fax: 402-758-5079
Mailing address:
  • Phone: 402-717-4377
  • Fax: 402-717-4317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: TIM BRICKER
Title or Position: CEO
Credential:
Phone: 541-610-8147